Denial code 23 applies to the medical billing process and involves disallowance of the payment request based on the insurance company. This denial is based on issues related to the previous payer, either making the payment or adjusting the claim. In simpler terms, denial code 23 means an insurance claim was handled inappropriately because of the last insurance provider’s actions.
Causes of Denial Code 23
There are several reasons for the denial of Code 23; some are avoidable, and others are not. Let us go through some of the usual reasons for this occurrence:
Payment Error or Adjustment Error: Sometimes, an error occurs on the payment or adjustment by the previous payer. The cause for this could be system errors and glitches, misunderstanding of claim details, or human error. This can occur when the prior insurance company does not process the matter on the claim correctly.
Insufficient paperwork: Lack of sufficient support documentation is another top cause of Denial code 23. If treatment notes or other relevant information necessary for claim provision are not present, the claim can easily be rejected.
Non-covered Services: Looking at what has been submitted, I see that some services are not covered by the patient’s insurance. This implies that the patient’s plan does not cover these services, contributing to Denial Code 23.
Coordination of Benefits (COB) Issues:
When more than one insurance member is offered to the patient, the need for coordination of benefits arises. If coordinating several insurers’ payments is erroneous, Denial Code 23 may be entered.
Incorrect Coding: When procedure or diagnosis codes have been incorrectly used, denials may arise from that. Whenever the codes on the claim do not reflect the services or procedures performed in the claim, this will cause the claim to be denied or modified.
Timely Filing: It is important to note that all insurance companies are allotted seriousness and exact time limits when submitting claims. Should the claim be made outside the beneficial time, denial code 23 will be applied.
Duplicate Claims: Seeking the same settled claims will warrant a denial. Insurance companies have rational policies that state that a claim viewed as a repetition will not be honored.
Contractual Issues: At times, a denial code 23 is assigned due to contractual terms shared by the healthcare provider with the payer. The existence of these differences will certainly lead to payment or adjustment difficulties or complications.
Resolving Denial Code 23
Understanding why this type of denial occurs, it would be worthwhile to consider the possible options for correcting the situation. There are several steps to take, which include:
EOB Verification: The first step is to review the EOB or Remittance Advice sent by the Insurance Company. Such explanation will be given for the previous payer’s payments or adjustments.
Payment Outcomes: Expectations based on agreed fee schedules or provisional rates should be compared to the previous payers who provided those made previously. This will help identify any discrepancies.
Consider Gathering: Ensure you have all necessary medical records and supporting documents ready to submit with your appeal.
Engage the Previous Payer: The first thing you should do is contact the last insurer and present information on the denial. Additional documentation or clarification may be needed to resolve the issue.
Appeals: Where one believes the denial was unmerited, the insurer’s policy on particular appeals should be observed. Ensure your appeal complies with the span of all required documents and is lodged before the time frame ends.
Appeals Monitoring: Following an adjudication, one submits an appeal; it is essential to note that one must also monitor its progress. Insurers should be contacted so that appeal processes remain operational.
Escalate if Necessary: If the previous payer has rejected the rebuttal or has left you high and dry with no solutions, consider seeking to step up the case in the firm themselves or calling in a specialist in the healthcare revenue cycle.
How to resolve Denial Code 23
Denial Code 23 must be avoided, as this would create needless payment lags. Below are some recommendations to assist with the situation.
Insurance Verification: Insurance verification should always be done before offering any services to the patient. This will make it easier to resolve issues surrounding prior payer adjudication.
Bill All Claims Accurately: All claims bills must be filed correctly, with the codes and accompanying documentation in order. The more errors in the claim, the more likely it will be refused.
Submit Timely Claims: Make it a point to submit your claims without unnecessary delay after services have been rendered. This ensures that deadlines are met and the physician does not risk being denied for filing late.
Check Claim Statuses: Make it a habit to check up on your claims regularly, and don’t hesitate to ask about unpaid claims. This enables you to nip problems in the bud and resolve them even before they reach the status of denial.
Be Updated: Updating your techniques in claim irrationalities may cover any new trends that refer to the payer’s policies. This will assist in avoiding non-compliance questions on the claims.
Frequently Asked Questions about Denial Code
Q: What is Denial Code 23 in medical billing?
A: Denial code 23 explains a claim that is denied because of poor adjustments made by the payer before the claim.
Q: What does Denial Code 23 mean in my claim?
A: Some of the common grounds for this denial are Wrong payment by past payors, such as other companies, insufficient records, services that are not covered, and coordinating of benefits problems.
Q: How do I fix Denial Code 23?
A: Examine the Explanation of Benefits, ensure all payments were made correctly, obtain necessary documentation, and speak with the person who last paid you. If need be, file an appeal.
Q: Do I have control of the circumstances that led to Denial Code 23?
A: Yes, you can control and eliminate this denial if you check for coverage, submit proper claims, file promptly, and understand the payers’ guidelines.
Q: Is it advisable to appeal the Denial Code 23 decision if it has already been denied?
A: If your appeal for this matter is unsuccessful, you can pursue it further with the previous payer’s organization or consult a healthcare billing expert.
Final Thought In conclusion, Denial Code 23 should be a thorn in the flesh of healthcare providers. However, by knowing its causes, one can take action to deal with it and prevent future situations that could give rise to them so that the losses incurred throughout the revenue cycle and specifically in the billing section are minimal. Suppose you seek resort medical billing denials or revenue cycle management services. In that case, Urgent RCM is available to serve you. Contact us now for professional assistance regarding medical billing.
